Heartburn and Acidity — Causes and When to Investigate
Also described as acidity, acid reflux, burning in chest, GERD.
Burning behind the breastbone after meals or on lying flat is usually acid reflux, helped by smaller meals, weight loss, and not lying down for three hours after eating. Difficulty swallowing, weight loss, vomiting or black stools change the picture and mean endoscopy.
🚨 Get emergency care if you have
- •Difficulty or pain on swallowing, or food sticking
- •Unintentional weight loss
- •Vomiting blood, or black tarry stools
- •Persistent vomiting
- •New symptoms starting after age 45, or a family history of stomach cancer
What causes heartburn?
Gastro-oesophageal reflux disease
Acid moving up from the stomach, worse when lying flat, after large meals or with excess weight.
Gastritis or peptic ulcer
Burning upper abdominal pain, often linked to H. pylori infection or painkiller use.
Hiatus hernia
Part of the stomach sitting above the diaphragm, making reflux more likely.
Painkiller-related irritation
Regular NSAIDs damaging the stomach lining, a very common and reversible cause.
Cardiac pain
Chest discomfort mistaken for acidity. Excluded first when there are risk factors.
How it is investigated
- ✓Upper GI endoscopy when alarm features are present
- ✓H. pylori testing — breath, stool or biopsy
- ✓Trial of acid suppression with review
- ✓ECG where cardiac pain is a possibility
Not every patient needs every test. The consultation decides which of these apply to you.
Frequently asked questions
When does acidity need an endoscopy?▼
When there are alarm features: difficulty swallowing, food sticking, weight loss, vomiting, blood in vomit or black stools, anaemia, or new symptoms after 45. Without those, a trial of treatment and lifestyle change is reasonable first.
Is it safe to take antacids long term?▼
Acid-suppressing medication is effective and generally well tolerated, but taking it indefinitely without review can mask a condition that needs diagnosing and has its own long-term considerations. If you have needed it daily for more than a few weeks, that is a reason to be assessed rather than to keep refilling.
This page is general health information, not a diagnosis or a substitute for a consultation. Symptoms overlap between harmless and serious conditions, and only an examination can tell them apart. If you are worried, see a doctor.
Plan your first visit
Not sure which specialist to see? Tell our care team the reason for your visit and we will help you choose.
- Bring previous prescriptions, relevant test reports or scan images, a medication list and photo ID.
- If you plan to use insurance, bring your policy details. OPD, tests and admission benefits depend on your individual plan and approval.
- Your first consultation determines which tests or treatments are needed; not everyone needs every test listed on this page.
Appointments are requests until confirmed. In a medical emergency, call 044 2025 2025 or go to the nearest emergency department.